Introduction and Objectives: HER-2 overexpression occurs in 20% to 30% of invasive breast carcinomas. Even in localized disease, it is considered aggressive and can spread rapidly if not treated early. This report depicts the case of a patient with Luminal HER breast cancer with extensive cutaneous and lymph node disease, without visceral metastasis. Case Report: A 58-year-old woman with a lesion in the anterior thoracic region, ulcerated, painful, and friable to manipulation, with approximately 13 cm in the largest axis, initially diagnosed as dermatofibrosarcoma protuberans. The lesion evolved with rapid progression in size, 17 cm in the longest axis, and was re-biopsied, revealing invasive breast carcinoma with positive immunohistochemistry for ER (90%), RP (50%), HER2+ (3+), positive FISH, and Ki67 (20%). Staging examinations, extensive disease in the anterior thoracic region and right lymph node, other examinations were negative for visceral metastatic disease. Discussion: This case presents an atypical evolution of Luminal HER breast carcinoma in which the unusual clinical presentation delayed diagnosis. Unlike the identified common presentation, in this case, an extensive ulcerated and friable lesion on the anterior chest wall with extensive cutaneous and lymph node involvement is observed. Furthermore, we emphasized the relevance of the pathological findings for the correct identification of the tumor, since after reanalysis, the diagnosis of dermatofibrosarcoma protuberans was disregard, and the presence of molecular breast carcinoma subtype luminal HER was identified, which brings changes in prognosis and therapy. Conclusion: Therefore, a completely atypical manifestation of a luminal malignant HER mammary neoplasm, without visceral disease, is perceived. Furthermore, the importance of the clinical and pathological findings in the diagnosis and therapeutic management for the case resulting from atypical clinical manifestations is emphasized. Therefore, the importance of this report to expose a completely anomalous manifestation of breast cancer, which without a good investigation would receive incorrect treatment, is noted.
Objectives: Breast cancer is the cancer with the highest incidence in women in Brazil. The revelation of this diagnosis is considered a crucial moment, responsible for uncertainties and even affecting the doctor–patient relationship. Although the communication of bad news is one of the most frequent practices among physicians, difficulties are common. The aim of this study was to evaluate the influence of the communication in the diagnosis of breast cancer and the repercussions on the treatment, using the parameters as suggested by the Centro Avançado de Diagnóstico de Câncer de Mama (CORA/ HC-UFG) in Goiânia-GO. Methodology: This qualitative and integrative study was conducted in the following databases: PubMed, SciELO, and MedLine with six selected articles. The keywords used were “communication,” “diagnosis,” “breast cancer,” “adherence to treatment,” and “doctor–patient relationship.” Based on the results, a comparison was made with the one carried out in the CORA/HC-UFG. Results: Through the analysis of the articles, it was observed that the no tification of the diagnosis of cancer is considered a critical moment and how professionals notify patients directly interferes in the relationship of the patients with the diagnosis itself. Thus, it is up to the professionals to provide psychological and informative support at the time of diagnosis in order to reduce pessimistic feelings and to avoid abandoning the medical–hospital follow-up. In addition, when analyzing the care provided at CORA, it was noted that the adoption of a more humanized and multiprofessional communication, with the help of the psychological team, it was noticed, in agreement with the studies, a better acceptance and treatment adherence. Conclusion: The notification of cancer should be done in the most empathetic way possible, using techniques of psychology and communication, so that the patient receives information about his health situation in a welcoming manner. Furthermore, although the diagnostic communication is a medical act, the presence of a psychologist to support the patient has shown benefits.
Background: Meningitis is an inflammatory process in the membranes that line the central nervous system (CNS). Objectives: To analyze the behavior of meningitis mortality rate by region of Brazil, between 2010 and 2019. Desing and setting: Analytical, observational and retrospective study. Deaths number from meningitis was recorded through the Mortality Information System (SIM) stratified by Brazilian region, and population data from IBGE. Methods: Mortality rate (MR) per 1 million inhabitants was calculated. MR trend in each region was provided by segmented linear regression. MR annual percentage changes (APCs) were adjusted with a 95% confidence interval (CI). Results: In this period, there were 10007 deaths from meningitis in Brazil. MR by region varied from 3.77 (North Region) to 6.03 (Southeast Region), while in Brazil it was 4.93. A decreasing trend is noticeable in Brazil MR (APC= -3.2; 95%CI= -3.9; -2.4). Central-West region had the largest drop (APC= - 4.1; 95%CI= - 7.9; -0.2), followed by Southeast. In contrast, South and North regions had stationary trend and Northeast had a double behavior: decreasing from 2010 to 2015 (APC= -7.7; 95%CI= -11.7; -3.5) and stationary from 2015 to 2019. Conclusions: Despite the country decreasing trend, these results are heterogeneous. Variables such as vaccination coverage, population adherence and socioeconomic status can influence meningitis MR trends. Thus, it is understood the need for programs aimed at disease treatment and prevention to reduce regional inequalities and meningitis mortality.
ResumoObjetivo: Relatar a experiência de acadêmicos em uma ação de educação em saúde para agentes comunitários de saúde (ACS). Método: Trata-se de um estudo descritivo do tipo Relato de Experiência obtido a partir de uma ação de educação em saúde realizada por doze
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